Welcome to the exciting world of ERISA! This blog is written by attorneys Kate MacKinnon and Sarah Demers at the Law Office of Katherine L. MacKinnon. Here, we'll talk about ERISA: updates on employee benefit law, information we hope people who have been denied benefits will find helpful, and any news or tidbits we think should be shared with the world.

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Tuesday, November 14, 2017

Medical insurance plans and policies only cover health care that is "medically necessary". Different plans define "medically necessary" in different ways, and health insurance companies often have to come up with some internal guidelines about what type of treatment will be covered for certain conditions, and when different treatment must be sought first.

This is difficult in claims involving mental health and substance abuse. Recently, a class action lawsuit was filed against United Behavioral Health ("UBH") asserting that the guidelines being used to deny claims were not in line with standard medical practice. The plaintiffs allege that UBH guidelines required claimants to receive a lower level of medical care than should have been given to them considering their medical conditions.